- Glucocorticoid secretion from the adrenal cortex is stimulated by adrenocorticotropic hormone (ACTH) or corticotropin that is released from the anterior pituitary in response to the hypothalamic-mediated release of corticotropin-releasing hormone (CRH).
- To ensure the proper treatment of Cushing's syndrome, diagnostic procedures should (1) establish the presence of hypercortisolism and (2) discover the underlying etiology of the disease.
- The rationale for treating Cushing's syndrome is to reduce the morbidity and mortality resulting from disorders such as diabetes mellitus, cardiovascular disease, and electrolyte abnormalities.
- The treatment of choice for both ACTH-dependent and ACTH-independent Cushing's syndrome is surgery, whereas pharmacologic agents are reserved for adjunctive therapy, refractory cases, or inoperable disease.
- Pharmacologic agents that may be used to manage the patient with Cushing's syndrome include steroidogenesis inhibitors, adrenolytic agents, neuromodulators of ACTH release, and glucocorticoid-receptor blocking agents.
- Spironolactone, a competitive aldosterone receptor antagonist, is the drug of choice in bilateral adrenal hyperplasia (BAH)-dependent hyperaldosteronism.
- Addison's disease (primary adrenal insufficiency) is a deficiency in cortisol, aldosterone, and various androgens resulting from the loss of function of all regions of the adrenal cortex.
- Secondary adrenal insufficiency usually results from exogenous steroid use, leading to hypothalamic-pituitary-adrenal (HPA)-axis suppression followed by a decrease in ACTH release, and low levels of androgens and cortisol.
- Virilism results from the excessive secretion of androgens from the adrenal gland and often manifests as hirsutism in females.
On completion of the chapter, the reader will be able to:
- 1. Describe the roles of the various zones of the adrenal
cortex in hormone synthesis.
- 2. Explain the regulation of glucocorticoid, adrenal androgen,
and mineralocorticoid secretion.
- 3. Describe and differentiate the various etiologies of Cushing's
- 4. Interpret the results of laboratory tests used to diagnose
- 5. Compare and contrast therapeutic regimens for treatment
of Cushing's syndrome, based on the etiology of the disease in a particular
- 6. Discuss the methods of, and rationale behind, steroid replacement
in the treatment of adrenal adenoma.
- 7. Explain the difference between primary and secondary aldosteronism.
- 8. Interpret the results of laboratory tests used to diagnose
- 9. Recommend a therapeutic regimen for treatment of primary
aldosteronism, based on the etiology of the disease in a particular
- 10. Compare and contrast the symptoms and presentation of
patients with primary and secondary adrenal insufficiency.
- 11. Construct a treatment plan for a patient with acute adrenal
- 12. Describe how specific enzyme deficiencies lead to congenital
- 13. List several options for the treatment of hirsutism.
- 14. Discuss some of the potential side effects of systemic
glucocorticoid use, and how the risk of developing these side effects
can be minimized.
- 15. Recommend appropriate counseling points for a patient
initiating long-term glucocorticoid therapy.
The adrenal glands were first characterized by Eustachius in 1563. After Addison identified a case of adrenal insufficiency in humans, adrenal anatomy and physiology flourished. Most of the work done in the early and mid-1900s centered on the glucocorticoid ...